Disorders of balance
- Symptoms of Disorders of balance
- Reasons of Disorders of balance
- Treatment of Disorders of balance
Balance disturbances - short-term or constant inability to management of position of a body in space, is shown by unstable gait, unexpected falling, rocking, a lack of coordination.
Balance disturbances often match dizziness, the nausea exhausting with vomiting, the general weakness.
Symptoms of Disorders of balance:
At the patient with the expressed hemiparesis when standing and walking will arise reduction in a shoulder, bending in elbow, radiocarpal joints and fingers, and in a leg — extension in coxofemoral, knee and talocrural joints. There are a complicated bending of a hip joint and bending of an ankle joint back. The Paretichny extremity vyyodvigatsya forward in such a way that foot hardly touches a floor. The leg uderzhivayotsya hardly and describes a semicircle, at first aside from a trunk, and then to it, making rotary motion. Often the movement of a leg causes an easy inclination of an upper half of a trunk to the opposite side. Dvizheyoniya a paretichny hand during walking usually happen limited. Loss of a wave of a hand when walking can be a precursory symptom of progressing of a hemiparesis. The patient with a moderate hemiparesis has same frustration, however they less expressed. In this case reduction of amplitude of scope of a hand during walking can be combined with hardly noticeable the arc-shaped dvizheyoniy legs, without the expressed rigidity or weakness in the affected extremities.
At the diseases of a spinal cord affecting the dvigatelyyony ways going to muscles of the lower extremities there are characteristic izmeyoneniye of gait caused by a combination of spasticity and weakness in legs. Walking demands a certain tension and is carried out by means of medyolenny rigid movements, in coxofemoral and knee joints. Legs are usually strained, slightly bent in coxofemoral and knee joints and taken away in a hip joint. At some patients of a leg can be braided continually and remind the movements of scissors. The step usually measured and short, can be shaken by the patient here and there, trying to compensate these rigidity in legs. Legs make the arc-shaped movements, feet shuffle about a floor, footwear soles at such patients are erased in socks.
At Parkinson's disease characteristic poses and gait develop. In a serious condition at patients note a flexion pose, with a bend forward in chest department of a backbone, a ducking down, sognuyoty hands in elbows and legs which are slightly bent in coxofemoral and knee joints. The patient sits or is motionless, note poverty of a mimicry, a redyoky blinking, the constant automatic movements in extremities. The patient seldom crosses legs or somehow differently adapts position of a body when sits on a chair. Though hands remain motionless, often note a tremor of fingers and a wrist with a frequency of 4-5 reductions of 1 page. At some patients the tremor rasyoprostranyatsya on elbows and shoulders. At late stages can note slyunotecheyony and a tremor of a mandible. The patient slowly starts walking. During walking the trunk bends forward, hands remain motionless or even more are bent and keep slightly ahead of a trunk. There are no waves hands when walking. At advance of a leg remain bent in coxofemoral, knee and talocrural joints. The fact that steps become настолько short that the feet are hardly shuffled on a floor is characteristic, soles shuffle and touch about a floor. If advance continues, steps become more and more bystry and the patient in the absence of support can fall (the tripping gait). If to push the patient forward or back, the compensatory flexion and extensive movements of a trunk will not arise and the patient will be forced to take a number of propulsive or retropulsivny steps. Patients with parkinsonism experience considerable difficulties at a rising from a chair or a start of motion after a motionless state. The patient begins walking with several small short steps, then length of a step increases.
Damage of a cerebellum.
Damages of a cerebellum and its bonds lead to considerable difficulties when standing the patient and walking without assistance. Difficulties are aggravated in attempt to go on the narrow line. Patients usually stand, having widely placed legs, standing in itself can cause the poshatyvany, krupnorazmashisty movements of a trunk forward and back. The attempt to put feet together leads to a poshatyvaniye or falling. Instability remains at the opened and closed eyes. The patient goes carefully, taking steps of various length and being shaken here and there; complains of naruyosheny balances, is afraid to go without support and leans on any objects, for example a bed or a chair, carefully moving ahead between them. Often simple touch to a wall or some subject allows to go quite surely. In case of moderate disturbances of gait of difficulty arise in attempt to go in a straight line. It leads to loss of an ustoychiyovost, the patient is forced to do the sharp movement by one leg aside to prevent falling. At hemilesions of a cerebellum of the patient eats towards defeat.
When defeat is limited to median formations of a cerebellum (worm) as, for example, at an alcoholic cerebellar degeneration, changes of a pose and gait can arise without other cerebellar frustration, such as an ataxy or a nystagmus.
Patients with a sensitive ataxy do not feel position of legs therefore experience difficulties both when standing, and when walking; there are they usually with widely placed legs; can keep balance if to ask them to put legs together and not to close an eye, however blindly they reel and often fall (a positive symptom of Romberg). Romberg's test cannot be carried out if the patient even with open eyes is not able to put legs together as it often happens at damages of a cerebellum.
Patients with a sensitive ataxy widely place legs when walking, podyonimat them above, than it is necessary, and are fitfully shaken forward and назад. Steps are various on length, feet make the characteristic clapping sounds at contact with a floor. The patient usually bends a trunk in tazoyobedrenny joints a little, when walking often uses a stick for a support. Visual impairments aggravate gait disturbances. Quite often patients lose stability and fall when washing as, closing eyes, they temporarily lose zriyotelny control.
This term call a set of various motive frustration, the majority of which arises owing to a hypoxia or ischemic injuries of the central nervous system to the perinatal period. Expressiveness of change of gait happens various depending on character and weight of defeat. Easy limited porayozheniye can cause increase in tendon jerks and Babinsky's symptom with moderate ekvinovarusny deformation of foot without the expressed gait disturbance. More expressed and extensive defeats, as a rule, lead to a bilateral hemiparesis. There are changes of poses and gait characteristic of a paraparesis; hands are taken away in shoulders and bent in elbows and wrists.
The cerebral palsy causes motive frustration in patients that can lead to gait change. Often the athetosis, характеризующийся slow or moderately bystry serpentine movements in hands and legs, the changing poses from extreme extent of bending and a supiyonation before the expressed extension and pronation develops. When walking such patients have involuntary movements in extremities which are followed by the vrayoshchatelny movements by a neck or grimaces on a face. Hands are usually bent, and legs are extended, however this asymmetry of extremities can be shown only at observation of the patient. For example, one hand can be bent and supinated, and another — is extended also a pronirovana. The asymmetric provision of konechyonost usually arises at turns of the head in the parties. As a rule, at a chin poyovorota in one of the parties the hand on this party is unbent, and the protiyovopolozhny hand is bent.
Patients with choreiform hyperkinesias often have gait nayorusheniye. The chorea most often develops at children with Sydenham's disease, at adults with a disease of Gentington and in rare instances at the patients with a paryokinsonizm receiving overdoses of antagonists of dopamine. The choreiform hyperkinesia is shown by the bystry movements of face muscles, trunks, a neck and extremities. There are flexion, extensive and rotary dviyozheniye of a neck, there are grimaces on a face, the rotating movements of a trunk and extremities, the movements of fingers of hands become bystry, as during the playing a piano. Often at an early chorea the flexion and extensive movements in hip joints appear, so an impression is made that bolyyony constantly crosses and straightens legs. The patient can involuntarily frown, look angrily or to smile. When walking choreic гиперкинез usually amplifies. The sudden tolchkoobrazny movements of a basin forward and in the parties and the bystry movements of a trunk and extremities lead to a voznikyonoveniye of the hopping gait. Steps are usually uneven, it is difficult for patient to pass in a straight line. Speed of movement happens various in a zayovisimost from speed and amplitude of each step.
Dystonia call the involuntary changes of poses and dviyozheniye developing at children (the deforming muscular dystonia, .il the torsion dystonia) and at adults (late dystonia). It can arise sporadic, have hereditary character or be shown as a part of druyogy pathological process, for example - Wilson's diseases. At the deformiruyuyoshchy muscular dystonia which is usually shown at children's age, gait disturbance happens the first symptom often. Gait with a little turned out foot when the patient lowers weight on the outer edge of foot is characteristic. When progressing a disease these difficulties are aggravated and often disturbances of poses develop: the raised position of one shoulder and a bedyor, a curvature of a trunk and excess bending in a radiocarpal joint and fingers of a hand. The alternating muscle tensions of a trunk and extremities complicate walking, the wryneck, a basin curvature, a lordosis and scoliosis in certain cases can develop. In the most hard cases of the patient loses a sposobyonost to move. Late dystonia, as a rule, leads to a similar nayorastaniye of motive frustration.
The expressed weakness of muscles of a trunk and proximal departments of legs leads to characteristic - changes of poses and gait. In attempt to rise from a sitting position of the patient bends forward, bends a trunk in hip joints, puts hands on knees and pushes a trunk up, leaning hands against hips. In a standing position note strong degree of a lordosis of lumbar department of a backbone and protrusion of a stomach owing to weakness of abdominal and juxtaspinal muscles. The patient goes with widely placed legs, weakness of gluteuses leads to development of "duck gait". Shoulders are usually inclined forward so when walking it is possible to see the movements of wings of a shovel.
Damage of a frontal lobe.
At bilateral damage of frontal lobes there is a characteristic change of gait which is often combined with dementia and symptoms of simplification of a frontal lobe, such as prehensile, sosatelyyony and hobotkovy reflexes. The patient costs with widely placed legs and makes the first step after preliminary quite long zayoderzhka. After these doubts of the patient there are very small shuffling short steps, then several steps of moderate amplitude after which the patient stiffens, not in forces to continue the movement, then the cycle is repeated. At such patients usually do not reveal muscular weakness, changes of tendinous refyoleks, sensitivity or Babinsky's symptoms. Usually the patient can execute the separate movements necessary for walking if to ask to reproduce him the movements of walking in a dorsal decubitus. Disturbance of a poyokhodka at damage of frontal lobes is a kind of apraxia, i.e. disturbance of performance of motive functions in the absence of weakness of the muscles participating in the movement.
Normotensive hydrocephaly (NTG) call the defeat which is characterized by dementia, apraxia and an incontience of urine. The axial computer tomography reveals rasshireyony cerebral cavities, expansion of a corner of a corpus collosum and an insufficient zayopolneniye of subarachnoid spaces of cerebral hemispheres spinnoyomozgovy liquid. At administration of radioactive isotopes in .subarakhnoidalny space of lumbar area of a backbone observe pathological throwing of isotope in ventricular system and its inadequate distribution to polusharny subarachnoid spaces.
Gait at NTG reminds that at apraxia owing to damage of frontal lobes, it consists of a number of the small, shuffling short steps making an impression that legs stick to a floor. The start of motion is complicated, vozniyokat slow moderate angular shift in coxofemoral, knee and golenoyostopny joints, the patient is low lifts feet over a floor, as if sliding them on a floor. There is a long reduction of muscles of legs which action is directed to overcoming gravity, and reduced activity of gastrocnemius muscles. Change of gait at NTG is result, apparently, of a naruyosheniye of activity of frontal lobes. Approximately at a half of patients with NTG gait improves after carrying out operation of shunting of cerebrospinal fluid from cerebral cavities in venous system.
Aging of an organism.
With age certain izmeyoneniye of gait develop and there are difficulties with balance deduction. At elderly people an upper part of a trunk slightly bends forward, shoulders fall, knees are bent, scope of hands when walking decreases, the step becomes shorter. At elderly women gait waddlingly develops. Disturbances of gait and stability contribute elderly people to falling.
Defeats of peripheral motor-neurons.
Defeat of peripheral motor-neurons or nerves leads to emergence of weakness in distal departments of extremities, to sagging of foot. At defeats of peripheral motor-neurons weakness in extremities develops in combination with fastsikulyation and an atrophy of muscles. The patient, as a rule, cannot bend foot back and compensates it by lifting of knees above, than usually that leads to a steppage. At weakness of proximal muscles gait waddlingly develops.
Disturbances of gait of hysterical genesis.
Disturbances of gait at hysteria usually arise in combination with hysterical paralyzes of one or more extremities. Gait is usually elaborate, very characteristic of hysteria and easily distinguishable from all other changes of gait arising owing to organic lesions. In some cases disturbances of gait of a different etiology can have similar manifestation that extremely complicates diagnosis. Disturbances of gait of a hysterical origin can arise irrespective of gender and age of patients.
At a hysterical hemiplegia of the patient drags the affected extremity on the ground, without leaning on it. From time to time it can move a paretichny leg forward and lean on it. The hand on the struck party often remains sluggish, hanging down without movements along a trunk, but is not in the bent state usually characteristic of a hemiplegia of an organic origin. At patients with a hysterical hemiparesis weakness is shown in the form of a so-called podkashivaniye.
Reasons of Disorders of balance:
Usually disturbances of balance are caused by changes of a vestibular mechanism, intoxications (alcoholic, food), traumatic and other damages of a head and spinal cord, diseases of an inner ear.
Treatment of Disorders of balance:
Carry out treatment of a basic disease.